Splenectomy: Spleen Removal Surgery

1
What Is a Splenectomy?

spleen image, healthy spleen, spleen location, spleen in situ, spleen
A Healthy Spleen. Image © ADAM

A splenectomy is the surgical removal of the spleen. There are two types of splenectomies -- the traditional open approach, using a full size incision, and the laparoscopic approach, which uses several very small incisions. Laparoscopic surgery is often referred to as minimally invasive surgery.

The laparoscopic procedure is the most common of the two splenectomy procedures and is typically used when possible by the surgeon. The procedure uses several small incisions and is often referred to as minimally invasive surgery. Due to the incision size, the laparoscopic approach minimizes both the pain of recovery and the risk of infection.

Not all patients’ anatomy or spleen conditions permit the laparoscopic procedure; in those situations, the open approach is used. It is also used when the spleen is being removed because of a condition called splenomegaly, or enlargement of the spleen. This is because the spleen may be too large to be removed through the much smaller laparoscopic incisions.

In some cases, the procedure may start as a laparoscopic surgery but the surgeon may opt to continue the surgery with an open incision if the spleen is discovered to be significantly enlarged.

During emergency surgery, such as after a car crash when the spleen has ruptured, the traditional open incision may be used to allow the surgeon to visualize the injury and to start the surgery faster. 

2
When Is Spleen Surgery an Emergency?

Three surgeons working in surgery/OR
Three Surgeons At Work. Image: © Janice Airey/Getty Images

A splenectomy, or spleen removal surgery, may be unavoidable in emergency circumstances. In the majority of cases where a splenectomy is performed emergently, or to save the patient’s life, the spleen has been damaged by trauma. The spleen is highly vascular, with many blood vessels and a large supply of blood, and it bleeds easily. If the bleeding cannot be controlled by other means, it must be removed surgically, or the patient may bleed to death. A car accident is a common cause of trauma to the spleen.

Spontaneous rupture, when the spleen bursts unexpectedly often for no clear reason, is very rare but also results in the need for emergency surgery.

3
Indications For Splenectomy?

A splenectomy, the surgery to remove the spleen, may be indicated in the following cases:

  • Blood clots
  • Hypersplenism: This is a condition where the spleen is hyperactive and destroying healthy blood cells.
  • Splenomegaly: Enlargement of the spleen
  • Cancer
  • Portal hypertension: This is a condition where the major blood vessel that leads to the liver has very high blood pressure. It can be caused by many different liver conditions, including cirrhosis and cancer.
  • Cirrhosis of the liver: This is a chronic liver disease where damaged tissue is replaced with scar tissue as damage is done. Blood does not flow as freely through the liver, causing portal hypertension.
  • Lymphoma: This type of cancer can cause enlargement of the spleen (splenomegaly).
  • Idiopathic thrombocytopenia purpura (ITP)
  • Spherocytic anemia: This type of anemia, where fragile blood cells are spherical in shape and damaged as they travel through the spleen, can be cured by a splenectomy.
  • Hemolytic anemia: Some types of hemolytic anemia, a condition where red blood cells are destroyed prematurely by the body, can be improved with the removal of the spleen.

4
Splenectomy Complications

In addition to the general risks associated with surgery and anesthesia, surgery to remove the spleen has its own potential complications. The spleen is a highly vascular organ, meaning that it has many blood vessels. This makes the spleen prone to bleeding when it is damaged or being operated on. If the spleen is seriously damaged and bleeding prior to surgery, the bleeding may actually continue during the surgery until the surgeon is able to locate the source of the bleeding and control it.

The spleen is tucked behind the stomach, below the diaphragm muscle and resting near the pancreas and intestine. Because of the proximity to other organs and structures, there is a slight risk that they can be damaged during the procedure.

The risk of infection is slightly higher with this procedure than with a typical surgery, not because of the surgical procedure itself, but because the spleen plays a role in fighting infection. Once the spleen is removed, the immune system does not function as well as it did prior to the surgery.

5
Splenectomy: The Laparoscopic Procedure

A splenectomy can be performed laparoscopically or using the open technique with a full size incision. While the vast majority of surgeries remove the entire spleen, it is possible to have a partial splenectomy, a procedure where only a portion of the organ is removed.

The surgery begins with the administration of anesthesia. Once the patient is unconscious, the surgery begins, typically with the introduction of five small incisions approximately 2 to 3 centimeters in length below the ribs on the left side. A tiny camera called a laparoscope is inserted into one of the incisions. The other incisions are used for the insertion of surgical instruments and the actual performance of the surgery. During the surgery, the surgeon views the space being operated on with the camera, as the incisions are too small to allow the surgeon to view the surgery directly.

The spleen has many blood vessels, so the surgeon finds the blood vessels leading to and from the spleen and places clips on them to permanently stop blood from flowing through to the spleen. The spleen is then cut away from the other structures of the body. When it is free, the spleen is placed in a sterile bag so it can be pulled out of the body through one of the incisions. If necessary, the incision can be slightly enlarged to permit the bag to pass through. This is done so no pieces of the spleen are able to break off and remain in the abdominal cavity, where they could cause serious infection.

Once the spleen has been removed and the surgeon has found no signs of continued bleeding, the instruments are removed and the incisions are closed. The incisions may be closed with surgical glue, steri-strips (small strips of adhesive bandage), or less frequently, staples or sutures.

6
Splenectomy: The Open Procedure

The open splenectomy procedure is very similar to the laparoscopic procedure with one main difference -- the incision used is approximately 4 to 5 inches long, and the surgeon is able to look into the incision to see the entire procedure.

This approach is especially useful in cases of splenomegaly, or enlargement of the spleen, which may make the spleen too large to be removed through the small incisions used in the minimally invasive procedure. If the spleen has been severely traumatized, the open procedure may also be used to allow the surgeon to better view the area and bleeding to be controlled more quickly than with the laparoscopic approach.

7
Recovering After Splenecotomy Surgery

Recovering after splenectomy surgery varies widely from patient to patient, largely because there are vastly different reasons for having a splenectomy. Regardless of the reason for your surgery, when you wake up from your surgery, you will feel some pain on your left side in the area of your stomach. You will also have a tube, called a nasogastric tube (NG), which goes in your nose, down your esophagus and into your stomach. This tube prevents the build up of stomach acid, minimizing nausea and vomiting after your procedure. The tube is usually removed a day or two after surgery.

The average patient is able to go home from the hospital 48 to 72 hours after surgery if the splenectomy was performed laparoscopically. An open procedure may require a longer stay, often up to a week, before being discharged. Most patients are able to resume their normal activities 4 to 6 weeks after surgery. However, a patient who requires a splenectomy after the spleen was traumatized may be hospitalized longer based on any additional injuries that may be present. In some cases, the damage to the spleen may be the most minor of the injuries.

The spleen is prone to bleeding when injured so you may require a blood transfusion after the procedure. This will depend upon the amount of blood lost before, during and after the procedure and is only done as needed. Without the transfusion, a patient who has experienced bleeding may feel weak or even lightheaded, due to the loss of blood.

It is extremely important that you are diligent about your incision care, as your wound can easily become infected after this surgery. Your incisions should be inspected for signs of infection on a daily basis or more often.

8
After Splenectomy

After a splenectomy, you will be more prone to infections and your body will not fight them as easily. You will need to be diligent about seeking medical care for conditions that you may not have immediately sought treatment for in the past, such as sore throats, fever, sinus and ear infections, and other common infections.

Your doctor will probably recommend that you receive the vaccine to prevent pneumonia and may suggest additional vaccines, such as the meningitis vaccine. Your resistance to infection will likely improve within two years of your surgery, but it is unlikely that it will ever return to preoperative levels.

If you are seeing a new physician or being treated for an unrelated problem, be sure to let the doctor know that you do not have a spleen.

Incision Care After Surgery

Sources:

After Your Spleen Has Been Removed: What You Need To Know To Protect Yourself. American Family Physician. http://www.aafp.org/afp/20010201/508ph.html

Congenital Spherocytic Anemia. MedLine Plus http://www.nlm.nih.gov/medlineplus/ency/article/000530.htm

Spleen Removal. MedLine Plus http://www.nlm.nih.gov/medlineplus/ency/article/002944.htm

Splenectomy. National Institutes of Health. [link ulr=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=surg.section.3057 ] http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=surg.section.3057

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